Ýntravasküler volümün korunmasý ve hemodinamik optimizasyonun saðlanmasý postoperatif morbidite ve mortalite üzerine önemli rol oynar. Sývý tedavisinin yönetiminde yeterli ve güvenli doku oksijenasyonunu saðlayacak kan akýmýnýn garanti edilmesi ve kalp debisinin metabolik ihtiyaçlarýn karþýlanmasýnda yeterli olup olmadýðýnýn belirlenmesi gerekmektedir. Kritik hastalarda intravasküler volüm durumunu doðru bir þekilde deðerlendirmeli ve sývý yüklemesini takiben geliþecek hemodinamik cevabý (yani hastanýn sývý yüklemeyle atým hacmini veya kalp debisini artýrýp arttýrmayacaðýný) öngörebilmeliyiz. Günümüzde, bazý hemodinamik monitörler, atým hacmini sürekli olarak hesaplayarak atým hacmi deðiþimi (SVV) ve nabýz basýncý deðiþimi (PPV) gibi dinamik parametreler saðlayabilmektedir. Hastalara optimum sývýyý vermek ve fazla sývýnýn yol açtýðý olasý olumsuzluklardan kaçýnmak için, sývý yanýtýný tahmin eden uygun hemodinamik monitorizasyon yapýlmalý ve akýlcý bir sývý stratejisi uygulanarak sývý tedavisi hasta için kiþiselleþtirilmelidir.

Maintaining volume status and optimising the hemodynamic parameters plays paramount importance on postoperative morbidity and mortality. In the management of fluid therapy it is required to guarantee blood flow to maintain sufficient and safe tissue oxygenation and determine if cardiac output is sufficient in maintaining the metabolic demand. In critically ill patients, intravascular volume status must be correctly assessed and hemodynamic response (ie if the patient is capable of increasing in stroke volume or cardiac output by fluid loading) following fluid overload could be foreseen. Nowadays, certain hemodynamic monitors, provide dynamic parameters like stroke volume variation (SVV) and pulse pressure variation by continuously calculating stoke volume. To infuse optimum amount of fluid and to avoid the negative effects of fluid overloading appropriate hemodynamic monitoring which predicts fluid response should be applied and by applying rational fluid strategy, fluid therapy should be individualized for the patient.

GÝRÝÞ ve AMAÇ: Çalýþmanýn amacý Airtraq ve Macintosh laringoskop ile yapýlan endotrakeal entübasyonda hemodinamik yanýtlarýn karþýlaþtýrýlmasýdýr.
YÖNTEM ve GEREÇLER: Etik Komite onayý alýndýktan sonra, ASA I grubunda, 18-65 yaþ arasý, havayolu anatomisi Mallampati I-II olan, elektif cerrahi geçirecek 60 hasta çalýþmaya alýndý. Randomize olarak iki gruba ayrýlan (n=30) hastalarýn kalp hýzý, noninvaziv sistolik, diyastolik ve ortalama arter basýncý, tidal sonu karbondioksit basýncý ve periferik oksijen satürasyonu monitörizas edildi. Grup M hastalar Macintosh, grup A Airtraq laringoskop ile entübe edildi. Hastalarýn anestezi indüksiyondan önce ve sonra, havayolu saðlama giriþiminden sonra 5 dk süresince hemodinamik veriler kaydedildi ve istatistiksel olarak deðerlendirildi.
BULGULAR: Her iki grup arasýnda preoperatif, 0.dk, 1.dk, 2.dk, 3.dk, 4.dk, ve 5.dk sistolik, diyastolik ve ortalama arter basýnçlarý ile kalp hýzlarý açýsýndan istatistiksel olarak anlamlý fark bulunmadý (p>0,05). Ancak iki grupta da sistolik, diyastolik ve ortalama arter basýnçlarý ile kalp hýzlarý 1.dakikada belirgin arttý. (p<0,05).
TARTIÞMA ve SONUÇ: Genel anestezi altýnda endotrakeal entübasyon uygulamasýnda Airtraq laringoskobun kolaylýk ve hemodinamik yanýt açýsýndan, Macintosh laringoskop ile eþit koþullar saðladýðý kanýsýna varýldý.

INTRODUCTION: The aim of this study was to compare the hemodynamic effects of the endotracheal intubation performed with Airtaq® (Prodol Meditec, Vizcaya, Spain) and Macintosh laryngoscopes.
METHODS: After approval by the Institutional Ethics Committe and obtaining patients’ written consents, 60 patients aged between 18 – 65 years, ASA group I, with Mallampati scores I - II undergoing elective surgery were included in the study. Patients were randomized into two groups (n=30). All patients had their heart rate (HR), non-invasive systolic arterial pressure (SAP), diastolic arterial pressure (DAP), mean arterial pressure (MAP), end-tidal carbondioksite pressure (ETCO2) and peripheral oxygen saturation (SpO2) monitored. Patients in the first and second groups were intubated using Macintosh and Airtraq laryngoscopes respectively. Hemodynamic parameters of all patients were recorded before induction (preop), after induction (0 min), and every 5 minutes after intubation. The recorded data were compared statistically.
RESULTS: There were no significant differences between two groups regarding demographic characteristics and Mallampati scores. Systolic, diastolic and mean arterial pressures and heart rate values in preoperative period and at 0., 1., 2., 3., 4., and 5. min did not show statistically significant differences between groups (p>0,05). In both of groups, systolic, diastolic and mean arterial pressure and heart rate values ​ increased significantly at 1.min (p<0,05).
DISCUSSION AND CONCLUSION: Airtraq laryngoscope was found comparable to Macintosh laryngoscope concerning ease of use and hemodynamic response to intubation.

GÝRÝÞ ve AMAÇ: Nonkardiyak cerrahi geçirecek kardiyak problemli hastalarýn preoperatif deðerlendirmesi oldukça kritiktir. Çalýþmamýzýn amacý; Amerikan Anestezistler Derneði (ASA) sýnýflamasý, Goldman skorlama sistemi ve kardiyoloji konsültasyonu ile belirlenen kardiyak risk ile perioperative mortalite ve morbidite arasýndaki iliþkinin araþtýrýlmasýdýr.
YÖNTEM ve GEREÇLER: Nonkardiyak cerrahi geçirecek, kardiyoloji konsültasyonu istenen 500 hasta prospektif olarak çalýþmaya alýndý. Hastalarýn ASA sýnýflarý, Goldman skorlarý, kardiyak riskleri, komorbiditeleri, operasyon tipleri, preoperative kardiyak semptomlarý ile perioperative mortalite ve morbidite arasýndaki iliþki deðerlendirildi.
BULGULAR: Morbidite geliþen grupta ortalama yaþ (69.3 ± 10.6) morbidite geliþmeyen gruba göre (64.0 ± 12.1) anlamlý olarak yüksekti (p < 0.001). Çalýþmamýzda perioperative mortalite gözlenmezken, 500 hastanýn 354 (%70,8) ünde kardiyovasküler komplikasyon geliþti. Operasyon tipi açýsýndan iki grup arasýnda anlamlý farklýlýk gözlenirken (p = 0.001), preoperatif hipertansiyon varlýðý morbidite geliþen grupta daha sýktý (p = 0.007). Ýki grubun preoperatif ASA sýnýflarý (p = 0.016), Goldman skorlarý (p < 0.001) ve kardiyoloji konsültasyon riskleri (p = 0.039) anlamlý olarak farklýydý. Yapýlan lojistik regresyon analizinde yalnýzca yaþ, hipertansiyon ve operasyon tipinin perioperative morbidite için risk faktörü olabileceði gösterildi.
TARTIÞMA ve SONUÇ: ASA sýnýflamasý, Goldman kardiyak risk indeksi ve kardiyolog tarafýndan belirlenen kardiyak risk; hastalarýn perioperatif yönetimini etkileyebilir. Ayrýca risk indeksleri ile algoritimlerin kullanýmýnýn; konsültasyon ihtiyacýný azaltarak gereksiz laboratuar ve görüntüleme tetkiki istemini dolayýsýyla cerrahinin gereksiz ertelenme ve iptalini önleyebileceðini düþünüyoruz.

INTRODUCTION: The preoperative evaluation of patients undergoing noncardiac surgery with cardiovascular disease is crucial. The aim of our study was to investigate the relationship between the American Society of Anesthesiologists (ASA) classification, Goldman scoring system, cardiac risk determined by the cardiologist, and the perioperative mortality and morbidity.
METHODS: 500 patients undergoing noncardiac surgery who were referred to a cardiologist were studied prospectively. The relationship between the patients’ ASA classes, Goldman scores, cardiac risks, comorbidities, operation types, preoperative cardiac symptoms, and perioperative morbidity and mortality was assessed.
RESULTS: The mean age in the group with morbidity (69.3 ± 10.6 years) was significantly higher than that in the group without morbidity (64.0 ± 12.1 years) (p < 0.001). There was no perioperative mortality, and of the 500 patients, 354 (70.8%) had cardiovascular complications. While the operation type of both groups was significantly different (p = 0.001), preoperative hypertension was more prevalent in the morbidity group (p = 0.007). The preoperative ASA classes (p = 0.016), Goldman scores (p < 0.001), and cardiac risks of patients (p = 0.039) were significantly different between the groups. Logistic regression analysis was applied, and only age, hypertension, and operation type were found to be risk factors for perioperative morbidity.
DISCUSSION AND CONCLUSION: We believe that ASA classification, Goldman Cardiac Risk Index, and cardiac risk determined can affect the patients’ perioperative management and the use of risk indices and algorithms can reduce the consultation requirement and unnecessary laboratory or imaging tests and can prevent the unnecessary cancellation or delaying of the surgery.

GÝRÝÞ ve AMAÇ: Bu çalýþmada koroner arter baypas (KABG) ameliyatý geçiren hastalara postoperatif süreçte parasetamol, diklofenak sodyum ve tramadol uygulamasýnýn postoperatif aðrý üzerine etkilerini karþýlaþtýrmayý amaçladýk.
YÖNTEM ve GEREÇLER: Etik komite ve bilgilendirilmiþ onamlarý alýnan KABG uygulanacak normal böbrek ve karaciðer fonksiyonlarýna sahip ve ejeksiyon fraksiyonu % 40 üzerinde olan 200 hasta çalýþmaya alýndý. Hastalar rastgele dört gruba ayrýldý; grup I (n=50) parasetamol IV, grup II (n=50) diklofenak sodyum IM, group III (n=50) IV tramadol alan hastalar, ve grup IV (n=50) plasebo. Grup IV de ki hastalar sadece 2 µg/kg/saat fentanil aldý. Hemodinamik ve biyokimyasal parametreler kaydedildi. Postoperatif aðrý vizüel analog skala (VAS) ile deðerlendirildi.
BULGULAR: Plesoba grubunda ekstübasyon zamaný daha uzun, PaCO2 seviyeleri ve ortalama kan basýncý diðer gruplara göre daha yüksekti. Diðer analjezi gruplarý arasýnda istatistiksel olarak anlamlý fark yoktu.
TARTIÞMA ve SONUÇ: Çalýþmamýzda IV parasetamol'ün analjezik etkisinin diklofenak ve tramadol'e benzer olduðu görüldü.

INTRODUCTION: The aim of this study was to compare the effects of paracetamol, diclofenac sodium, and tramadol administration in the postoperative period for the patients who underwent coronary artery bypass grafting (CABG) on postoperative pain.

METHODS: After the approval of ethics committee and informed consent 200 patients who undergoing CABG with normal renal and liver functions and an ejection fraction value of 40 % were included. The patients were randomly divided into four groups: group I (n=50) patients received paracetamol (IV), group II (n=50) patients received diclofenac sodium(IM), group III (n=50) patients received tramadol(IV), and group IV (n=50) patients received placebo. Group IV was given only 2 µg/kg/h of fentanyl for 2 hours. Hemodynamic values and biochemical parameters were recorded. Postoperative pain was assessed using visuel analog scale(VAS).
RESULTS: In the placebo group, PaCO2 levels were higher, mean arterial pressure was higher and extubation time was longer than the other groups. There was no statistically significant difference between the three analgesia groups.
DISCUSSION AND CONCLUSION: Based on our study results, analgesic effect of IV paracetamol appears to be similar to diclofenac and tramadol.

GÝRÝÞ ve AMAÇ: Yoðun bakým ünitesinde yatan hastalarda yineleyen intravenöz (IV) yollara ulaþýmýn zorluðu çok sýk karþýlaþýlan bir sorundur. Santral venöz kateterizasyon (SVK) bu yüzden sýk kullanýlan bir yöntemdir. Çalýþmamýzýn amacý, hastanemizin yoðun bakým ünitesinde gerçekleþtirilen juguler ve subklavyen santral venöz kateter yerleþtirme iþlemlerimizdeki baþarý oraný ve komplikasyon sýklýðýný retrospektif olarak deðerlendirmektir.
YÖNTEM ve GEREÇLER: Çalýþmamýzda Ocak 2010 – Mart 2013 tarihleri arasýnda kliniðimizde santral venöz kateter uygulanan 211 hastanýn demografik verileri, primer tanýlarý, giriþim sayýsý, komplikasyon sýklýðý kaydedildi. Hastalar giriþ venlerine göre sað internal juguler ven (Grup J) ve sað subklavyen ven (Grup S) olarak deðerlendirildi.
BULGULAR: Hastalarýn 72’si (%34.1) kadýn 139’u (%65.9) erkekti. Hastalarýn yaþ aralýklarý 28-96, yaþ ortalamasý ise 70,89±11,32 yýldýr. Olgularýn %55,9’una (n=118) Juguler kateter, %44,1’ine (n=93) Subklavyen kateter uygulanmýþtýr. Komplikasyon %13,7’sinde (n=29) saptanmýþtýr. Bu olgularýn %31,0 (n=9) enfeksiyon, %24,2’sinde (n=7) pnömotorax ve %44,8’inde (n=13) hematom gözlenmiþtir.
TARTIÞMA ve SONUÇ: SVK oldukça sýk baþvurulan ve ciddi komplikasyon riski olan giriþimsel bir iþlemdir. SVK takýlmasý sonrasýnda olgularýn yakýn takibinin komplikasyonlarýn sýklýðýný azaltýp erken tanýnmasýna yol açacaðý düþüncesindeyiz.

INTRODUCTION: The difficulty of accessing recurrent intravenous (IV) routes in intensive care unit (ICU) patients is a frequently encountered problem. Central venous catheterization has been increasingly used. The aim of this study was to evaluate retrospectively the successfull catheterization incidence and complications of juguler and subclavian central venous catheterization.
METHODS: We retrospectively reviewed the files of 211 ICU patients who underwent central venous catherisation between January 2010-March 2013. Patients demographic data, primary diagnoses, number of interventions, the frequency of complications, were recorded. Patients were evaluated as right internal jugular vein (Group J) and right subclavian vein (Group S) groups according to their entrance.
RESULTS: 72 patients (%34.1) were female and 139 (%65.9) were male. The ages ranged from 28-96 years and the mean age was 70.89 +11.32 years. %55.9 internal juguler catheterisations were performed and %44.1 subclavian catheterisations were performed. The complication seen in %13.7 (29) due to the infection %31 (n: 9), %24.2 (n: 7) pneumothorax, %44.8 (n: 13) haematoma.
DISCUSSION AND CONCLUSION: Central venous catheterization is an important issue both in follow-up and management period of the patients, but have some complications. Close observation of patients after catheterization is considerable for determining and management of complications.

Ekstrakorporal membran oksijenizasyonu (ECMO) hayatý tehdit eden kalp ve akciðer yetmezliði durumlarýnda, bu organlarýn görevini üstlenen bir makinedir. ECMO tedavisi sýrasýnda birçok komplikasyon görülebilir. Bizim sunacaðýmýz olguda da periferik katatere baðlý geliþen bacak iskemisi ve yönetimi tartýþýlacaktýr.

Extracorporeal membrane oxygenation (ECMO) is a machine that undertakes the role of these organs in life-threatening conditions of the heart and lung. Many complications can be seen during ECMO treatment. We will discuss the development and management of leg cramps due to peripheral catheters.

Koroner arter baypas greft cerrahisinde safen ven greft olarak kullanýlmaktadýr. Greftin distal ve proksimal anastomozlar arasýnda uygun boy ve eðimde olmasý gerekir. Böylece yeterli kan akýmý saðlanarak miyokard iyi beslenir. Koroner arter baypas ameliyatý sonrasýnda uzun safen ven greftinin katlanmasý sonucu ST elevasyon geliþen bir olguyu sunmaktayýz. Bu olgu sunumu ile koroner arter baypas greft ameliyatý geçirenlerde yakýn takip ve monitorizasyonun önemini vurgulamayý amaçladýk.

Saphenous vein is used as a graft in coronary artery bypass graft surgery. The graft must be of appropriate length and inclination between the distal and proximal anastomoses. Thus, myocardium is fed well by providing sufficient blood flow. We present a case of ST elevation resulting in folding of a long safen ven graft after coronary artery bypass surgery. In this case report, we aimed to emphasize the importance of close follow-up and monitoring in patients who underwent coronary artery bypass graft surgery.